Choose which optional cookies and similar storage we may use. Strictly necessary storage is always on, because the site cannot work without it.
Talk to us

AI for insurers and health payers

Insurers and health payers want lower claims costs and healthier members, without exposing the people in their data. We build privacy-first tools for risk and claims integrity, and we are developing Averra, a digital health twin, for insurers and payers.

Last updated

Challenges we help with

  • Claims leakage, and fraud, waste and abuse that is hard to see in time.
  • Rising claims costs, and the case for prevention.
  • Engaging members between claims.
  • Using sensitive health data without exposing the people it describes.
  • New obligations for AI used in insurance risk assessment and pricing.

What is changing for insurers?

AI is moving from pilots into claims and underwriting intake, while rules on AI in pricing, conduct and data arrive on fixed dates. What is in use now, and what is coming, with the source for each.

In use now

Coming next

  • High-risk rules for life and health insurance pricing

    Under the EU AI Act, as amended by Regulation (EU) 2026/1744, AI used for risk assessment and pricing in life and health insurance is high-risk from 2 December 2027. Insurers using it will need human oversight, an impact assessment and explanations for the people affected.

    Sources Regulation (EU) 2026/1744 (Digital Omnibus on AI) (EUR-Lex, 2026); AI Omnibus enters into force (European Commission, 2026)

  • The London market moves on data standards

    Lloyd's retired the Blueprint Two programme in March 2026, but the Core Data Record goes on as the London market's shared data standard, with delegated authority and claims versions consulted on in 2026.

    Sources Blueprint Two (Lloyd's, 2026); Data Council launches consultation for Delegated Authority Core Data Record (London Market Group, 2026)

  • Supervisors will ask about every AI system

    US regulators piloted an AI Systems Evaluation Tool for insurance examinations from March to September 2026, and the PRA named AI adoption as a supervision topic for insurers in 2026. Expect structured questions about each AI system you use and who oversees it.

    Sources AI Systems Evaluation Tool pilot project summary (NAIC, 2026); Insurance supervision: 2026 priorities (Prudential Regulation Authority, 2026)

  • Solvency II adds climate risk

    The Solvency II review, Directive (EU) 2025/2, applies from 30 January 2027 and brings climate and sustainability risk into insurers' risk management, with more exposure and scenario data to prepare.

    Source Directive (EU) 2025/2 amending Directive 2009/138/EC (Solvency II) (EUR-Lex, 2025)

Checked against these sources on . Rules and dates change: we check them again at the start of every project.

What we offer

AI agents for insurers and payers

Agents for claims, underwriting and customer teams. Each one gathers, drafts and routes; a person decides cover, claims and prices.

Claims

  • Claims intake agent

    Takes first notice of a claim by phone, web or email, gathers the details and documents, and opens the claim in your claims system.

    A person approves Cover, liability and settlement. It never accepts or declines a claim.

  • Claims triage agent

    Sorts new claims by complexity and urgency, routes each to the right handler, and says why.

    A person approves Handlers can change any routing, and customers who may be vulnerable go straight to a person.

  • Claims integrity review agent

    Flags claims whose patterns may point to fraud, waste or overcharging, with the evidence behind each flag, for your counter-fraud team.

    A person approves Every flag. A person decides what happens next, and no claim is refused on a flag alone.

  • Recovery and subrogation agent

    Finds settled claims where another party may be liable, and prepares the recovery file.

    A person approves Whether to pursue a recovery, and every letter to the other party.

Underwriting

  • Underwriting submission agent

    Reads broker submissions, from emails, schedules and slips, into structured risk data, and checks each against your appetite.

    A person approves Every underwriting decision, term and price.

  • Policy wording agent

    Compares policy wordings and endorsements with your standard wording, and marks each difference for review.

    A person approves An underwriter or wording specialist signs off every change.

  • Bordereaux and delegated authority agent

    Checks coverholders' and MGAs' bordereaux against your binding authority and the market's data standards, and lists every exception.

    A person approves The delegated authority manager clears every exception.

Health payers

  • Prior authorisation agent

    Gathers the clinical documents a health payer's rules ask for, prepares each prior authorisation request and tracks it to a decision.

    A person approves A licensed clinician makes every medical necessity decision. The agent never refuses a request.

Customers and conduct

  • Policyholder service agent

    Answers policy and claim status questions by phone, chat and email, in the caller's own language, and passes complex cases to your team.

    A person approves Anything about cover, a claim decision or a complaint goes to a person.

  • Customer outcomes agent

    Reviews calls, letters and complaints for signs of poor outcomes or unfair treatment, and gathers the evidence for your Consumer Duty reporting.

    A person approves The findings, and what goes to your board.

Every agent is logged, tested before launch and after every change, and given only the access its task needs. How we keep agents in control

The systems they connect to

An agent is only useful inside the systems your teams already work in. These are the platforms and standards insurers and brokers run on.

Policy and claims platforms

Guidewire InsuranceSuite, Duck Creek, Sapiens, Majesco, Salesforce Financial Services Cloud.

Broker and agency systems

Applied Epic, Acturis, Open GI, SSP.

Data standards

ACORD standards (AL3, XML and its JSON standards for APIs), ACORD delegated authority standards, Core Data Record and MRC v3 (London market).

Fraud and claims data

CUE and the Motor Insurance Database (MIB), Insurance Fraud Bureau, Cifas, Verisk ISO ClaimSearch.

Access to each is through its provider's own membership rules.

Health payers

HL7 FHIR and the Da Vinci guides, X12 837 and 835 claims, DHA eClaimLink in Dubai, DoH Shafafiya in Abu Dhabi.

We connect through each system's own interfaces, its open standards and the Model Context Protocol (MCP), and confirm each connection at the start of a project. Naming a product here does not mean we are its maker's partner.

Standards and safeguards

  • People review consequential decisions: our tools inform them.
  • Designed around UK GDPR, including its rules on automated decision-making.
  • Designed with the EU AI Act in mind, which classes AI for risk assessment and pricing in life and health insurance as high-risk.

Evidence

  • Gateway Global has filed three UK patent applications, including one on controlling where AI processing requests can go. See our patent portfolio
  • With Prime Edge AI, every device attests itself in hardware and routine processing stays on the device. Read how it works

Questions people ask

Is Averra ready for insurers yet?

Not yet. Averra is in development. It is designed for insurers and health payers, and you can register your interest.

Do your tools decide claims?

No. They point to patterns for a person to review. Decisions about people stay with people.

Can you work with anonymised data?

Yes. Anonymisation, pseudonymisation and redaction are part of our privacy engineering work.

Tell us about your portfolio.

Talk to us about your portfolio